Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 56728-020 | WI |
N | 207RC0200X | Critical Care Medicine | 84155 | GA |
N | 207RP1001X | Pulmonary Disease | 56728-020 | WI |
Y | 207RP1001X | Pulmonary Disease | 84155 | GA |
NPI | 1093039851 |
---|---|
Provider Name | Dr. Molla Y. Teshome |
First Address | Atlanta, GA 30374-2616 |
Second Address | Gainesville, GA 30501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2010 |
Last Update Date | 08/12/2021 |